Seeking the Light at the End of a Cancer Treatment Journey

WORDS LIM TECK CHOON

Khariza Abdul Khalid has a blessed life. At 47, she is the Executive Director of Gamuda Land and a mother of 3 precious children.

However, it was not always rosy for Khariza, for in 2012, the discovery of an unusual bulging on her left stomach led to a diagnosis of stage 3 non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma is a type of cancer that starts in the lymphatic system—a network comprising our lymphatic vessels, lymph nodes, lymphoid organs, lymphoid tissues, and lymph fluid. When one develops this cancer, their white blood cells grow in an abnormal manner, forming tumours throughout the body.
A SHOCK, THEN COMES DETERMINATION

“I was scared, worried, nervous,” recalls Khariza, “but I was informed that I would have to go through chemotherapy.”

Fortunately, her husband and parents were very supportive, acting as the rock for her to stay strong and supported throughout her cancer treatment journey.

Her parents even stepped in to care for her children during the period.

A LONG JOURNEY

“I had to go for 6 cycles of chemotherapy and a bone marrow transplant,” Khariza shares with us.

Each cycle took place in a month, and she would, depending on her health condition, have 2 weeks of rest or staying in the ward for 3 to 4 days.

During this period, she took a year leave from work.

“I’m grateful for the support from not only my family, but also my employer and colleagues,” she tells us.

Additionally, she is also grateful for the compassionate care, understanding, and support she received from the doctors, nurses, and other hospital staff during her treatment journey.

“Don’t worry too much,” Khariza advises others that are embarking on their cancer treatment journey. “It is not an easy road, but you will get through this!”

A HOPEFUL FUTURE

By the end of the 6th cycle, Khariza received the news that she had been hoping to hear: her cancer cells had been eliminated.

She would undergo immediate bone marrow transplant, to replace bone marrow damaged during chemotherapy and to regenerate her immune system.

These days, Khariza is feeling more like her old self.

“I am blessed,” she says. “I am feeling heathier and more energetic too, as I have added exercises and workouts into my daily routine.

Not taking life for granted anymore, she also devotes more time to bond with her family and friends.

Michelle Yeoh Joins Local Healthcare NGOs in Rallying Malaysians Against COVID-19

WORDS LIM TECK CHOON

On 17 August 2023, the Malaysian Society of Infection Control and Infectious Disease (MyICID), the National Cancer Society of Malaysia (NCSM), and the Malaysian Red Crescent (MRCS), in collaboration with Pfizer Malaysia, launched the MyPELINDUNG campaign.

WHAT’S MyPELINDUNG?

It’s a public educational campaign aimed at mitigating the threat of COVID-19 in Malaysia by increasing the awareness levels of Malaysians on the importance of up-to-date vaccination and seeking of prompt COVID-19-specific treatment.

Among the luminaries gracing the launch were:

  • Her Highness Dato’ Seri DiRaja Tan Sri Tunku Puteri Intan Safinaz binti Almarhum Sultan Abdul Halim Mu’adzam Shah, Tunku Temenggong Kedah, who is the National Chairperson of the Malaysian Red Crescent
  • Datuk Dr Norhayati Rusli, Deputy Director-General of Public Health, Ministry of Health
  • Yang Berbahagia Tan Sri Dato’ Seri Michelle Yeoh, Oscar-winning actress
  • Dr Shaharudeen Bin Kamaludeen, the President of MyICID
  • Dato Dr. Saunthari Somasundaram, the President of NCSM
  • Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life
  • Madam Luksanawan Thangpaibool, the Country Cluster Lead of Pfizer Malaysia, Pakistan and Brunei
A PRINCESS’S WORD OF WISDOM

“Just as it takes many drops to form an ocean, our shared actions—however small they may seem —can create significant impact in the fight against COVID-19,” says Yang Teramat Mulia Dato’ Seri Diraja Tan Sri Tunku Puteri Intan Safinaz.

She adds: “It’s through initiatives like MyPELINDUNG that we can harness our collective strength to navigate this health issue. Together, with the strength of unity and shared responsibility, we can contribute to a healthier, safer nation for all Malaysians.”

WAIT, ISN’T COVID-19 OLD NEWS?

Not so! Yes, Malaysia has made significant strides but the virus responsible for COVID-19 continues to circulate in our communities and can still lead to hospitalizations and even death, especially among high-risk groups.

Hence, the experts driving MyPELINDUNG advocates constant vigilance, updating of COVID-19 vaccinations, adherence to recommended health measures, and prompt seeking of COVID-19-specific treatment if one is tested positive.

VACCINATION IS KEY, EXPERTS SAY

MyPELINDUNG aims to reduce public hesitancy around the COVID-19 booster doses by disseminating scientifically-accurate information and addressing common concerns held by Malaysians about these boosters.

The campaign’s efforts will particularly focus on high-risk groups, as up-to-date vaccination (including booster doses) can reduce their risk of severe illness, hospitalization, and death.

Dr Shaharudeen Kamaludeen, President of MyICID, tells us: “It’s paramount that we understand the critical role vaccinations play in mitigating the severity of COVID-19. Vaccinations, including recommended booster doses, are our primary line of defence against this virus.”

He also adds that prompt medical consultation and treatment after a positive test for COVID-19 are equally vital.

Professor Datuk Dr Zulkifli Ismail, the Chairman of Immunise4Life, further emphasizes the importance of maintaining one’s up-to-date vaccination status.

“Full vaccination significantly reduces the risk of severe disease outcomes,” he says. “We urge everyone, particularly those in high-risk groups, to consider vaccinations as their personal shield against the virus, and to remember that this shield is most robust when all recommended doses, including boosters, have been administered.”

THE ACTRESS ADVOCATES

Tan Sri Dato’ Seri Michelle Yeoh concurs with the experts, adding that she herself had 2 brushes with the COVID-19 vaccine.

She participated in an educational video for MyPELINDUNG, a video that she is very proud of, and will continue to commit to encouraging Malaysians to remain vigilant and take the appropriate protective steps against COVID-19.

“Trust the science,” she urges.

PROMPT & QUICK TREATMENT CAN SAVE LIVES

“The most important thing to remember about treatment for COVID-19 is that it should be started as soon as possible after diagnosis to be effective,” states Dato Dr Saunthari Somasundram. “If you test positive for COVID-19, treatments are available that can reduce the likelihood of severe illness, hospitalization, and death. Please don’t delay because COVID-19 specific treatment must be started within days after you first develop symptoms to be effective.”

Tan Sri Michelle Yeoh concurs. “On screen, I’ve navigated flying stunts and leapt off moving vehicles, but life isn’t an action film, and we can’t afford to wait for the dramatic last-minute rescue. If you’re showing any symptoms, act fast, seek help at once.”

For more information about the MyPELINDUNG initiative and its efforts to combat COVID-19, please visit https://www.facebook.com/MyPELINDUNG (link opens in a new tab).

A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again

WORDS LIM TECK CHOON

FEATURED EXPERT
DR FOONG CHEE CHOONG
Consultant Rehabilitation Medicine Specialist
Sunway Medical Centre Velocity
FIRST, LET’S TAKE A LOOK AT GAIT THERAPY

Gait therapy is a form of physical therapy to help improve one’s ability to walk.

COMMON HEALTH ISSUES THAT LEAVE ONE WITH DIFFICULTIES IN WALKING
Stroke
Osteoarthritis
Cerebral palsy
Parkinson’s disease
Joint replacement surgery
Lower limb paralysis
Multiple sclerosis
Traumatic brain injury
Muscle weakness due to long periods of inactivity or immobilization

Gait therapy is typically conducted by a rehabilitation medicine specialist together with a physiotherapist and assisting personnel such as nurses.

If the affected person needs counselling or experiences mental issues such as depression due to their inability to walk normally, a counselor or psychiatrist will also be involved.

INTRODUCING ROBOTIC-ASSISTED GAIT THERAPY

Consultant rehabilitation medicine specialist Dr Foong Chee Chong reveals that this technology has been around for the last decade or so, and it is increasingly adopted in Malaysia as part of gait therapy.

It’s a bit like Tony Stark and the Iron Man suit!

Dr Foong shares that in robotic-assisted gait therapy, the robotic device used is a wearable robotic exoskeleton.

There are a few different types of robotic exoskeletons available, and the specific way each works may vary from other types.

However, they generally work in the following manner:

  1.  There is a control panel, placed usually at the back of the exoskeleton, that allows the physiotherapist to adjust the settings to the level of assistance needed by the patient. Such adjustment is based on the patient’s current abilities and needs.
  2. The robotic exoskeleton is a lightweight frame that will be strapped onto the patient’s torso and legs.
  3. Once activated, the robotic exoskeleton will provide powered assistance to the patient’s hips and knees, assisting the patient in performing walking and standing motions.
  4. The entire session will be supervised closely by the physiotherapist and their assistant, who will always remain close to the patient.
  5. Should the patient do something wrong, the robotic exoskeleton will emit a sound that will alert the supervising physiotherapist, so that they can tend to the patient and provide necessary advice and assistance.
What’s the benefit of using a robotic exoskeleton?

Improved rehabilitation. Studies have found that robotic-assisted gait therapy can lead to clinically significant improvements in lower-limb movements among stroke survivors and people with spinal cord injuries, when compared to conventional gait therapy.

Shorter rehabilitation period. Dr Foong points out that, unlike the human eye, the robotic exoskeleton is more precise in detecting issues faced by the patient as they try to walk during gait therapy.

Furthermore, data from each session is tracked to allow the physiotherapist and rehabilitation medicine specialist to review the patient’s progress and identity areas for improvement.

As a result, the patient’s gait recovery from their robotic-assisted gait therapy is usually faster than those that do not use this technology.

Less resources are needed. Conventional gait therapy requires more personnel to assist the patient. For example, Dr Foong mentions that an assistant may be needed to support each of the patient’s arms, while another will guide the movement of the patient’s legs.

With the use of the robotic exoskeleton, fewer personnel are needed.

CAN I SIGN UP FOR ROBOTIC-ASSISTED GAIT THERAPY?

Dr Foong points out that a person will need to meet certain criteria to be considered for such therapy.

The person can sit upright and stand without experiencing dizziness and other issues. “They need to be able to do these actions at least 30 to 45 minutes without experiencing dizziness and other issues,” Dr Fong explains.

The person’s joints and bones are supple and strong enough to move without experiencing fractures. Dr Foong says that, typically, medical examination and muscle strength assessment will be conducted first to determine whether a patient is suitable to put on the robotic exoskeleton.

The person’s mind is sharp enough. They need to have a sound mind and be able to follow instructions from the physiotherapist.

The person is within the stipulated height and weight limit. A robotic exoskeleton can only support a person up to a certain weight and is within the recommended height range.

For the Ekso machine, for example, it can fit patients under 100 kg and between 1.5 m and 1.9 m.

HOW LONG IS EACH SESSION?

“Each session is usually between 30 and 45 minutes,” Dr Foong says.

The number of sessions is determined on a case-by-case basis.

WILL I BE ABLE TO WALK LIKE I USED TO?

“It will depend on a few factors,” Dr Foong says.  “The most important factor is the severity of the stroke. However, majority of stroke survivors will regain some form of movement or ambulation after undergoing robotic rehabilitation.”

He adds that one’s walking ability typically declines over time due to age-related issues such as loss of muscle strength. Hence, it’s possible that one may need to undergo periodic gait training to improve their walking ability.

Additionally, Dr Foong recommends staying active to ensure that the improvements developed after gait therapy will persist for as long as example. For example, one can go for walks around the neighbourhood in the evenings.

THIS IS THE FIRST PART OF THE SERIES LEARNING TO WALK AGAIN

Below are the articles in this series:

  1. A Rehab Specialist Explains How a Robot Can Help You to Learn Safely & Successfully to Walk Again (this is the article you are reading now)
  2. How Robotics Can Help a Stroke Survivor’s Brain to Relearn How to Walk at a Faster Rate

A Cardiologist Talks About a Procedure to Treat Coronary Artery Disease

WORDS DR TIMOTHY JAMES WATSON

FEATURED EXPERT
DR TIMOTHY JAMES WATSON
Consultant Cardiologist
Pantai Hospital Batu Pahat
PERCUTANEOUS CORONARY INTERVENTION

Percutaneous coronary intervention (PCI for short) is a mechanical solution for obstructive coronary artery disease.

An overview of coronary artery disease. Click image for a larger, clearer version.

This solution essentially pushing the plaques to the side of the vessel to restore blood flow to the heart.

Stents and balloons are used to widen the blood vessel affected by plaque that blocks blood flow. Click the image for a larger, clearer version.

Firstly, this helps to relieve symptoms and, in unstable patients, saves lives.

Nonetheless, it doesn’t reverse the atherosclerotic process.

However, the advent of newer technologies such as drug-eluting balloons likely help with positive remodeling of the artery, such as enlargement without needing a stent.

ATTACHING A FINE ULTRASOUND CAMERA TO PCI CAN IMPROVE OUTCOME

During the coronary angiogram, a fine ultrasound camera is inserted into the angiogram catheter and fed into the heart blood vessel.

The ultrasound camera is then slowly withdrawn whilst taking a series of pictures from inside the blood vessel.

The doctor can then use these pictures to get live data of the plaque and size of the blood vessel to help make treatment decisions.

This procedure, called intravascular ultrasound-guided percutaneous coronary intervention (IVUS-guided PCI), has been repeatedly shown to improve outcomes and is highly recommended in many cases.

The IVUS procedure takes only 5 minutes or so and the patient will be unaware of what is going on.

PREPARING FOR A PERCUTANEOUS CORONARY INTERVENTION

Percutaneous coronary intervention is generally a straightforward and fairly low-risk procedure.

  • Of course, feelings of anxiety are natural. So, it is best to come to the hospital with a friend or family to accompany you.
  • Eat all your medications as normal, especially the blood thinning medication.
  • For the diabetes medication, your doctor may ask you to withhold one or two doses before/after the procedure.
  • Prolonged fasting is generally not required pre-procedure. A few hours should be ample.
AFTER THE PROCEDURE

In the majority of cases recovery from PCI is very rapid.

There may be some discomfort or bruising at the puncture site, but this should quickly resolve within a few days to a week.

Thereafter most patients will be back to normal very quickly.

A Haematologist Explains Why You Should Consider Donating Your Blood

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HO KIM WAH
Consultant Haematologist and Transplant Physician
Sunway Medical Centre
BLOOD DONATION SAVES LIVES

Blood transports oxygen and nutrients to the cells in every nook and corner of your body and carries waste products away from these cells for elimination.

While this seems like a simple statement, its importance cannot be understated. Your body cannot function properly when there is not enough blood in your body to perform its life-sustaining function.

“That is why blood donation is extremely crucial, especially for those born with hereditary blood disorders or have contracted blood cancers that prevent their bone marrow from producing healthy blood cells naturally,” says Dr Ho Kim Wah.

ARE THERE RISKS OF DONATING BLOOD?

According to Dr Ho, the risk of donating blood is fairly minimal as long as the donor fulfills the qualification to become a blood donor.

You can be a blood donor if you:

  • Meet the age criteria (between 17 and 60 years old).
  • Aren’t fasting.
  • Are within your ideal body weight range.
  • Have had more than 5 hours of sleep before donating blood.
  • Are physically and mentally sound.
  • Have no chronic diseases.

There may be other criteria, but don’t worry. You will be first examined by a medical officer to determine whether you are eligible to donate blood. You can also take the opportunity to ask the medical officer about any concerns you may have.

IS BLOOD DONATION A TAXING PROCEDURE?

Not particularly. The entire process of blood donation takes only about 30 minutes or so.

Dr Ho points out that after donating your blood, you will be advised to rest for at least 10 minutes.

You should have some light refreshments and to drink plenty of water in the meantime.

You should also avoid strenuous activities in the first 24 hours after blood donation, to avoid unpredictable fainting spells that can occur as a result of these activities.

“In any case, if you develop symptoms such as fever, chills, rigours, chest pain, sweatiness, itchiness, breathlessness, or any sense of uneasiness, you should notify the nurses or doctors immediately,” advises Dr Ho.

NO, THESE WOULD NOT HAPPEN IF YOU DONATE YOUR BLOOD!

Reduce your lifespan. No, this won’t happen.

Damage your internal organs. That’s not true.

Contract infections. Stringent measures are taken to avoid this.

Have your blood discarded and hence wasted when the blood bank has too much blood stored. Any surplus in a blood bank is transported to areas that are in need of such blood.

1 BAG OF DONATED BLOOD WILL SAVE 3 LIVES

“Take a stand and save a life,” Dr Ho urges.

To donate blood, you can visit the National Blood Centre at Jalan Tun Razak, Kuala Lumpur or the state hospital nearest to you. You can also keep an eye out for mobile blood donation programmes visiting your neighbourhood from time to time.

First Large-Scale Diabetes Cohort Study Launched in Malaysia

WORDS LIM TECK CHOON

On 10 July 2023, the Seremban Diabetes (SeDia) Cohort Study, was officially launched by Duli Yang Maha Mulia Yang Di Pertuan Besar Negeri Sembilan, Tuanku Muhriz ibni Almarhum Tuanku Munawir in Seremban.

PURPOSE OF THE SeDia COHORT STUDY

This study was launched to holistically explore all the factors involved in the development of diabetes as well as the complications experienced by people with diabetes in this country.

THE HISTORY OF THE STUDY

The genesis of the SeDia Cohort Story began on 17 May 2022 when the Ministry of Health Malaysia and the International Medical University signed a memorandum of understanding for the establishment of this study.

The research protocol of the study received the approval of the Medical Research and Ethics Committee (MREC) on 17 March 2023.

OVER 12,000 PARTICIPANTS SIGNED UP TO AID INVESTIGATION

This SeDia Cohort Study will cover a period of 12 years.

The first important step now is to obtain data that is socio-culturally relevant to the local community. So far, over 5,000 patients and over 7,000 of their family members have voluntarily registered as part of the Diabetes Registry of Klinik Kesihatan Seremban.

The investigators will use digital systems and data infrastructure to collect these participants’ personal and medical information.

Blood samples will also be obtained from these participants for genetic profiling, to study individual predisposition to diabetes and, for people with diabetes, their predisposition to complications and response to medications as well as physical and dietary interventions.

These participants will be followed regularly, with the process of data collection conducted every 3 years over the next 12 years.

Additionally, details of the participants’ life events, such as hospital admission and deaths, will be collected and updated every year.

STUDY HOPES TO IMPROVE DIABETES PREVENTION & MANAGEMENT IN MALAYSIA

Using the data obtained from these participants, the investigators will study and analyze the complex web of factors that contribute to the development of diabetes and its complications.

These factors include genetics and family history of diabetes to lifestyle and environmental factors, dietary regimes, physical activity, socio-economic levels, and healthcare delivery.

The investigators believe that the understanding of these complex factors and the connection between them would enable us to uncover optimal strategies for diabetes prevention and treatment.

Such strategies would enable implementation of evidence-based policies and programmes to address the escalating burden of diabetes in Malaysia.

ACCESS WILL BE GRANTED TO LOCAL & INTERNATIONAL RESEARCHERS

To establish the SeDia Cohort as a study of national significance, local and international researchers will be granted access to SeDia Cohort to conduct further analysis and studies, subject to approval of the MREC.

FUNDING INFORMATION

The SeDia Cohort study will be funded through public funds, which includes contributions from corporations and individuals.

Top Dengue-Related Highlights from the Dengue Prevention Advocacy Malaysia Launch

WORDS LIM TECK CHOON

ABOUT THE DENGUE PREVENTION ADVOCACY MALAYSIA (DPAM) GROUP
  • DPAM is an independent advocacy group co-jointly led by the Malaysian Paediatric Association (MPA), the Malaysian Society of Infection Control and Infectious Disease (MyICID), the Malaysian Society of Infectious Diseases and Chemotherapy (MSIDC), and the Malaysian Public Health Physicians Association (PPPKAM).
  • DPAM collaborates with the Malaysian Society of Parasitology and Tropical Medicine (MSPTM), the Malaysian Medical Association (MMA), Asia-Pacific Academic Consortium for Public Health Kuala Lumpur (APACPH-KL) and Rotary International District 3300.
  • DPAM is established to support the efforts of the Ministry of Health in strengthening dengue prevention, management, and control in Malaysia.
WHY DPAM IS NECESSARY: A POTENTIAL EMERGING DENGUE EMERGENCY
FEATURED EXPERT
DR HUSNINA IBRAHIM
Deputy Director of Disease Control Division (Communicable Diseases)
Ministry of Health Malaysia
  • Malaysia had its worst dengue outbreak in 2019, over 130,000 cases and 182 deaths.
  • The numbers declined during the MCO a few years ago. During this new normal, however, dengue numbers are once again on the rise.
  • From January to epidemiology week-22 this year, there has been a 158% rise in dengue cases and 183% increase in the deaths compared with the same period last year.

Dr Husnina Ibrahim, the Deputy Director of Disease Control Division (Communicable Diseases), said: “As Malaysia typically experiences a surge in dengue cases every 4 to 5 years, it was projected that an outbreak is due around this or next year, with an estimated number of cases potentially surpassing the historic 2019 outbreak.”

RECENT ADVANCES YIELD POSITIVE RESULTS IN THE PREVENTION & CONTROL OF DENGUE
Wolbachia-infected mosquitoes
  • The introduction of Wolbachia-infected mosquitoes has significantly reduced dengue cases in 16 out of 19 localities, by 33% to 100%.
  • Wolbachia is a type of bacteria that can infect many species of invertebrates—organism with no backbone—including mosquitoes such as Aedes aegypti, the mosquito that carries and spreads the dengue viruses.
  • Male Aedes aegypti infected with Wolbachia will mate with female mosquitoes, but the resulting eggs will not hatch.
  • This reduces the number of Aedes aegypti mosquitoes.
Implementation of comprehensive guidelines, proper training, and a critical review of dengue mortality

These efforts have reduced the case-fatality rate by 87.3% from 2000 to 2022.

SETTING TARGETS FOR FUTURE DENGUE PREVENTION & CONTROL EFFORTS
  • The Ministry of Health has in place the National Dengue Prevention and Control Strategic Plan 2022-2026, which aims to annually reduce the number of dengue cases by 5% while maintaining the proportion of deaths compared to the number of cases (case fatality rate or CFR) below 0.2%.
  • The Ministry aims to reduce the CFR to 0% by 2030—which is to say, there should be no deaths due to dengue by that year.
DPAM TO PLAY AN ACTIVE ROLE IN SUPPORTING THE EFFORTS OF THE MINISTRY OF HEALTH TO ACHIEVE THESE TARGETS
FEATURED EXPERT
PROFESSOR DATUK DR ZULKIFLI ISMAIL
Consultant Paediatrician and Paediatric Cardiologist
Chairman of the Dengue Prevention Advocacy Malaysia (DPAM)

Professor Datuk Dr. Zulkifli Ismail expresses his optimism that the Ministry of Health’s aforementioned targets are achievable with the active involvement of key stakeholders such as the government, civil society, academia, private sector, media, and the community.

DPAM aims to synergize efforts by various of these stakeholders in assisting the Ministry of Health to achieve its national and global dengue targets through the strengthening of dengue prevention, management, and control in Malaysia.

He said, “DPAM will focus its efforts on healthcare professional and public education and communication, local research, guideline recommendations, as well as policy recommendations.”

To foster and strengthen regional collaborations, DPAM will work closely with the Asian Dengue Voice & Action (ADVA), a regional advocacy group. Their first collaborative initiative is the hosting of the 7th Asia Dengue Summit in Malaysia next year.

DPAM also released a Resolution Paper that contained key strategies for all relevant stakeholders to create a “whole of society” approach.

Medical Professionals Galvanize to Tackle Obesity Pandemic in Malaysia with Release of Revised Clinical Practice Guidelines

WORDS LIM TECK CHOON

We’ve all read about it and probably memorized the statistics by now: Malaysia is among the heaviest countries in Asia, if not the world. Perhaps unsurprisingly, there is also a high prevalence of chronic diseases such as type 2 diabetes, high blood pressure, and others that are linked to obesity.

AN URGENT IMPETUS TO CURB THE OBESITY PANDEMIC IN MALAYSIA

Obesity is classified as a chronic or long-term disease. As such, Malaysian healthcare professionals have banded together in their commitment to provide Malaysians with the best treatment options and accessibility to these treatments.

A milestone in this commitment took place on 9 June 2023, with the release of the 2nd edition of the Clinical Practice Guidelines for the Management of Obesity.

The clinical practice guidelines are jointly published by the Ministry of Health Malaysia, the Malaysian Endocrine & Metabolic Society (MEMS), the Malaysian Society for the Study of Obesity (MASO), the Malaysian Dietitians’ Association (MDA), and Family Medicine Specialists Association of Malaysia (FMSA)—a multidisciplinary collaboration comprising endocrinologists, dietitians, and more.

The launch of the clinical practice guidelines was officiated by Dr Mohd Ridzwan Shahari, the Deputy Director of Medical Development Branch of the Medical Development Division, representing Dato’ Dr Asmayani Khalib, Deputy Director-General of Health (Medical) of the Ministry of Health Malaysia.

AN UPDATED BLUEPRINT OF NEW & ROBUST STRATEGIES TO PREVENT & MANAGE OBESITY

The initial edition of the clinical practice guidelines was released in 2004. With almost 20 years since then, much had changed when it comes to prevalence of, attitude towards, and management approaches for obesity.

As Dr Nurain Mohd Noor the President of MEMS, puts it: “Overweight and obesity in Malaysia is growing with every passing year. Based on the National Health and Morbidity Survey, in 2011, the prevalence was already at 44.5%, and in 2019, it has risen to a staggering 50.1%, whereby half of the population is now classified as overweight or obese.”

As such, the revision of the existing clinical practice guidelines is most timely and necessary. Professor Dr Norlaila Mustafa, Chairperson of the CPG Development Committee, reveals that the committee attracted experts from diverse field—endocrinology, psychology, dietetics, sports medicine, family medicine, paediatric endocrinology—to revise the existing guidelines to incorporate breakthroughs and advances that offer promising solutions in the last 20 years.

Some of the revisions and expansions include:

  • Expanding the range of recommended medications and medical procedures to treat obesity.
  • Updates on medical nutrition therapy to introduce successful and effective changes to a patient’s diet.
  • Emphasis on psychological interventions, such as cognitive behavioural therapy, to motivate patients into adopting and maintaining lifestyle changes to maintain a healthy weight.

With regards to the third point, Prof Dr Norlaila brings up tools include the Binge Eating Scale, which helps to identify individuals with binge eating disorder, ‘SMART’ strategy that aids in a patient’s goal setting, and problem-solving techniques such as ‘IDEAL’ to support patients when faced with setbacks in their weight management journey.

A NEW BASIS FOR BODY MASS INDEX

A key issue raised during the launch was the need for a lower cut-off point for diagnosis of overweight and obesity among Asians.

This is because the current body mass index or BMI system was initially based on the physiology and fat composition of Caucasians.

Asians, on the other hand, typically have shorter height and higher body fat percentages. Research has shown that the risk of type 2 diabetes, high blood pressure, and other weight-associated chronic diseases tend to rise for Asians at a lower BMI point.

Hence, based on evidence gathered from research on Asians, the following BMI categories are recommended for use in Malaysia:

BMI CATEGORY
23 to 27.4 kg/m2 Overweight
27.5 kg/m2 and above Obese
A FOUNDATION FOR A ROLLOUT OF IMPROVED PREVENTION & MANAGEMENT OF OBESITY PROGRAMME IN MALAYSIA

Prof Dr Norlaila shares her hopes that the release of the revised Clinical Practice Guidelines for the Management of Obesity will become a primary cornerstone for treatment and prevention, as well as health awareness programmes in Malaysia.

She reveals that future plans include making weight management and obesity treatment services available in more primary healthcare points such as general practitioners, educational talks and programmes in schools, and more.

Interested healthcare professionals can download a digital copy of the Clinical Practice Guidelines for the Management of Obesity (2nd Edition) at the Academy of Medicine of Malaysia here (link opens in a new tab).

Great News! Now More Children Are Eligible for Free Pneumococcal Vaccination!

WORDS LIM TECK CHOON

In conjunction with World Immunization Week from 24 to 30 April, the Ministry of Health held a National Immunisation Day 2023 on 31 May 2023.

The event was a collaboration between various divisions in the Ministry of Health’s Public Health Programme and Immunise4Life (link opens in a new tab).

THE BIG CATCH-UP

The theme of National Immunisation Day this year is ‘Tingkatkan liputan, kurangkan keciciran’ or ‘The Big Catch-up’.

Dr Zaliha Mustafa, our Minister of Health, revealed that this theme is in line with the expansion of Malaysia’s free pneumococcal vaccination programme to those born between 2018 and 2019. This expansion will commence from June 1.

Pneumococcal vaccine was included in the National Immunisation Programme (link opens in new tab) to initially cover children born from January 1 in 2020.

With this expansion, our Ministry of Health hopes to target 70% or 700,000 of the 1 million children aged 4 to 5 under the two-year programme.

“The nationwide pneumococcal vaccination programme will start on June 1 until May 31 next year and it will involve the ministry’s primary healthcare facilities,” she explained.

Interested parents can set an appointment for their children’s vaccination using the MySejahtera app.

WHY KIDS SHOULD GET THE PNEUMOCOCCAL VACCINE

Pneumococcal disease, an infection caused by bacteria called Streptococcus pneumoniae is contagious and may cause severe illness, so early diagnosis and treatment is important.

Children 2 years old or younger are vulnerable to such infection.

Hence, these children are also at risk of developing serious, potentially life-threatening complications such as:

  • Pneumonia, which is the infection and inflammation of the air sacs in our lungs
  • Ear infections
  • Meningitis, which is the inflammation of a membrane called meninges in the spinal cord and brain
  • Bacteraemia, or infection of the bloodstream
Pneumococcal pneumonia is a lung infection caused by the bacteria responsible for pneumococcal disease. Click on the image for a larger, clearer version.

Once the bacteria infect the bloodstream, they can find their way to parts of the body that are normally sterile, such as the peritoneum—that’s the membrane lining our abdominal cavity—as well as our joints and heart. This can lead to many more invasive diseases, such as peritonitis, arthritis, and endocarditis (inflammation of the inner layer of the heart) respectively.

Hence, parents with children that are eligible for the free vaccination should consider taking advantage of the expansion of Malaysia’s free pneumococcal vaccine programme. They can consult a doctor should they have any doubts and concerns about the vaccine.

“Don’t Let Diabetes Ruin Your Eyesight!” Warns Expert

WORDS LIM TECK CHOON

FEATURED EXPERT
DR PEH KHAIK KEE
Consultant Ophthalmologist and Vitreoretinal Surgeon
Sunway Medical Centre
DIABETES IS THE MOST COMMON CAUSE OF BLINDNESS AMONG WORKING-AGE ADULTS

“1 in 5 Malaysians is diabetic, which equals to an estimated 4.6 million Malaysians, and diabetic eye disease affects 1 in 3 diabetics. That means about 500,000 of these people will experience vision-threatening eye disease,” says Dr Peh Khaik Kee.

DIABETIC RETINOPATHY IS A DIABETES-LINKED EYE DISEASE THAT CAN LEAD TO VISION LOSS

According to Dr Peh, diabetes affects the eye in several ways:

  • It causes changes to the lens, leading to blurry vision.
  • Increased pressure in the eye can lead to glaucoma.
  • Damages the nerves that control the eye muscles, giving rise double vision.
  • Damages the blood vessels in the retina, leading to diabetic retinopathy.
Overview of diabetic retinopathy. Click on the image for a larger, clearer version.

Dr Peh shares: “Diabetic retinopathy has become of epidemic proportions. A large part of this issue is due to poor awareness. Many people with diabetes do not undergo regular eye exams to check for signs of the condition.”

REGULAR EYE EXAMS ARE IMPORTANT BECAUSE EARLY STAGE DIABETIC RETINOPATHY DOES NOT SHOW ANY SYMPTOMS

Vision loss occurs at late-stage diabetic retinopathy—this is when most people affected by this disease seeks medical help.

Dark spots floating around in the person’s vision (floaters) are a possible symptom of diabetic retinopathy.

Unfortunately, the vision loss is permanent, and at that stage, there is little to be done to improve the person’s eyesight.

On the other hand, should diabetic retinopathy be detected at its early stages, treatment can be prescribed to help slow down or stop the vision loss over time.

“That is where the importance of screening comes in,” Dr Peh said.

EYE SCREENING FOR DIABETIC RETINOPATHY IS MORE COMFORTABLE THESE DAYS

In the past, such screening can involve staring at a bright light for up to 5 minutes for each eye, which can be very uncomfortable for some people.

Dr Peh shares that the eye screening process has improved since. “These days we have ultra-widefield fundus cameras that can capture a single, 150-degree field view of the retina; 3 times more field view than a standard camera.”

He adds that the camera captures images in under 1 minute, with up to 98% accuracy in detecting and grading retina disease when combined with targeted slit-lamp examination.

Thus, the screening process is faster and hence the person undergoing screening will have a more comfortable experience, while at the same time offering a high accuracy rate in detecting diabetic retinopathy.

EYE SCREENING MAKES A DIFFERENCE

“Diabetic eye screening was formally initiated in the UK in 2009, and by 2014, diabetes is no longer the commonest cause of blindness in working adults in the UK. That is the difference that screening makes,” says Dr Peh.

WHO SHOULD GO FOR EYE SCREENING?

Dr Peh encourages those with a family history of diabetes to have their blood sugar screened, and those diagnosed with diabetes should see an ophthalmologist to have their retina examined.